Connecticut Nurse Midwives Fight For Equal Health Care Pay

Eliza Holland, a certified nurse midwife, sees patients in private practice in North Branford and New Haven. She says nurse midwives should get equal Medicaid reimbursement pay for the services they provide.

Nicole Leonard
/ Connecticut Public Radio

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Brianne Foley didn’t have time to plan for the birth of her first child. So when she and her husband were having their second child, Foley did extensive research on which ones accepted Medicaid and were within driving distance of her home in Watertown.

That’s when she found a practice run by certified nurse midwives.

“Women in Connecticut or women all over who don’t have the opportunity to have births attended by midwives because there just isn’t enough around, they can’t get to them or they don’t take their insurance, especially for Medicaid, are missing out on actually proven opportunities for improved health outcomes for mom and baby,” Foley said.

Certified nurse midwives are state licensed independent practitioners who specialize in women’s health care and sometimes work within larger health care teams.

They provide a lot of the same services that OB/GYN doctors do, like prescribe birth control, perform annual exams, and oversee pregnancies and births.

But when nurse midwives see Medicaid patients in Connecticut, they get paid less than other practitioners in the field. Nurse midwives like Eliza Holland said change is long overdue.

“This is an inequity that has been corrected already through the Affordable Care Act for Medicare as well as in the rest of the New England states,” she said. “They all are reimbursing their nurse midwives dollar for dollar.”

Medicaid, which is a national safety net program for low-income and disabled residents, is funded jointly by the federal government and the states.

Individual states oversee and administer the program, and can help set Medicaid reimbursement rates, or payments to doctors, nurses and other health care workers for the services they provide to patients.

Within that scope, certified nurse midwives in Connecticut get reimbursed about 90 cents for every dollar that an OB/GYN gets reimbursed for the same service.

A bill with the state Joint Committee on Human Services would fix that problem. Lawmakers heard public testimony last week, but there has not yet been a vote.

“I think it is an idea whose time has come to Connecticut, even though we’re a little late to the game, but I am, I’m optimistic,” Holland said. “I’m hopeful that people will see the value of it.”

Eliza Holland, a certified nurse midwife in North Branford and New Haven, said midwife practices want to serve Medicaid patients, but may have to cap the number of women they see because of inadequate reimbursement from the program.

Credit Nicole Leonard / Connecticut Public Radio

Holland works in private practice and sees patients in North Branford and New Haven. While nurse midwife practices want to care for Medicaid patients, she said they still need to make enough money to pay rent and staff.

Sometimes, that means capping the number of Medicaid patients or births they can do in a year, “and we hate to do that,” she said. “We really want to be able to care for everybody.”

The American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives reaffirmed in a joint statement last year that there should be equal pay for equal work.

Nancy Burton, a retired nurse midwife and current lecturer at the Yale School of Nursing, said closing the reimbursement gap could save the state money since nurse midwife births tend to have lower C-section rates and fewer complications, and therefore less costly.

But she fears the state’s budget crisis might make it hard to effect change.

“The timing is tough because of the financial constraints in the state, and that could hold us back. It just seems so clear that midwifery care will save money,” Burton said.

Most importantly, she said a change could lead to better overall health care for women, a goal shared by all kinds of health providers in the field.

“We’re in this because we want to take care of people,” she said. “Part of taking care of people is helping to ensure that they can actually access the care they need.”

Connecticut lawmakers are taking a closer look at how crisis pregnancy centers advertise their services to women. The state Public Health Committee heard testimony this week on a bill that would make it illegal for centers to be “false, misleading or deceptive” in what they offer in reproductive medical services, counseling or treatment.